DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, PALAKKAD

Dated this the  24^th day of March, 2023

Present      :   Sri. Vinay Menon V.,  President

                  :  Smt. Vidya A., Member                                                          Date of Filing: 19/09/2019   

                         CC/227/2019

1. Kairali,

W/o.Late Krishnankutty,

Thekkethil House,

Nellikurissi, Mulanjur,

Ottapalam, Palakkad.

2. Mookami Amma,

M/o.Late Krishnankutty,

Thekkethil House,

Nellikurissi, Mulanjur,

Ottapalam, Palakkad.

3. Anoop Krishnan, Aged 23,

S/o.Late Krishnankutty,

Thekkethil House,

Nellikurissi, Mulanjur,

Ottapalam, Palakkad.

4. Akhil Krishna, Aged 20,

S/o.Late Krishnankutty,

Thekkethil House,

Nellikurissi, Mulanjur,

Ottapalam, Palakkad.                                                -                       Complainants

       (By Adv.T.U.Shaik Abdulla)

                                                                                                Vs

1. Managing Director,

IFFCO Tokio General Insurance Co.Ltd.,

Mumbai Retail SBU,

3^rd Floor, Iffco Bhavan,

181, Waterfield Road

2. SBI, Ottapalam Branch,

Ponnani Road, Ottapalam                              -                       Opposite parties

       (O.P.1 by Adv.P.Prasad &

        OP.2  by K.N.Ramakrishnan)

O R D E R

By  Sri. Vinay Menon V., President

1. Quintessentially, complainants, legal heirs of one deceased Krishnan Kutty, pleads that the deceased was covered by an insurance policy issued by the 1^st opposite party by virtue of being an account holder of the Addl. 2^nd O.P. Due to stress and tension of the job, the insured died due to a cardiac arrest. This death due to cardiac arrest tantamount to accidental death and therefore the complainants raised a claim before the 1^st O.P. 1^st O.P. repudiated the claim. Aggrieved thereby, this complaint is filed.
2. Both O.P.s filed versions accepting the cause of death of the deceased, but contested that cardiac arrest was not an accident and hence not covered by the policy. They sought for dismissal of the complaint.
3. The following issues arise for consideration:

1. Whether the cause of death of the insured, cardiac arrest, covered under the policy?
2. Whether there is any deficiency in service on the part of the opposite parties?
3. Whether the complainants are entitled to any of the reliefs sought for?
4. Reliefs and cost?

4.         (i)         Even after opportunities being granted, the complainants failed to adduce any

 evidence.

            (ii)        O.P.1 filed proof affidavit and filed Exts. B1 to B5.

            Issue No. 1

5.         Facts being as aforesaid, the sole question that requires to be considered is whether cardiac arrest is an accident covered under Ext. B1 policy schedule.

6.         Ext. B1 is the policy schedule. The relevant portion of Ext. B1 that pertains to the facts and circumstances of this case is in page 12(unnumbered) of Ext. B1, Clause B. “TERMS AND CONDITIONS OF GROUP PERSONAL ACCIDENT (DEATH COVER ONLY)”

            Unnumbered paragraph 2: “Now this Policy witnesses that subject to and in consideration………………………………………….. , the Company shall pay to the INSURED to the extent and in the manner hereinafter provided that if any of the Insured Persons shall

1. Sustain death resulting solely directly from accident caused by external, violent and visible means, the sum hereinafter set forth in respect of any of the injured persons specified in the Schedule.
   1. ……………………………………………
   2. ……………………………………………”

7.         What Ext. B1 covers, relevant to the facts herein, is death resulting solely and directly from accident that is a result of some cause that is external, violent and visible. We fail to see how cardiac arrest is an accident caused by external, violent and visible means.

8.         Thus we hold that cardiac arrest is not covered under Ext. B1 policy.

            Issue No. 2 & 3

9.         Banking on the findings in Issue No. 1, we find no deficiency in service on the part of the opposite parties. Hence the complaint is dismissed.

            Issue Nos. 4

10.       In the facts and circumstances of the case, the parties are directed to bear their respective costs.

                  Pronounced in open court on this the 24^th  day of March   , 2023.         

        Sd/-

                                                                                                Vinay Menon V

                                                      President

      Sd/-

   Vidya.A

                       Member       

APPENDIX

Exhibits marked on the side of the complainant :  Nil  

Exhibits marked on the side of the opposite party:  

Ext.B1 – Policy Schedule pertaining to Group Personal Accident Insurance Policy for Salary

               Package Account Holders of SBI

Ext.B2 - Original of claim form

Ext.B3 – Certified copy of PMR bearing No.89/18, dated 20/8/18

Ext.B4 – Certificate issued by SBI

Ext.B5 – Copy of repudiation letter

 Court Exhibit:  Nil

Third party documents:  Nil

Witness examined on the side of the complainant: Nil

Witness examined on the side of the opposite party:  Nil

Court Witness: Nil

NB : Parties are directed to take back all extra set of  documents submitted in the proceedings in accordance with Regulation 20(5) of the Consumer Protection (Consumer Commission Procedure) Regulations, 2020 failing which they will be weeded out.